abstract: 'Background: Social equity in the efficacy of behavior change

  intervention is much needed. While the efficacy of brief alcohol

  interventions (BAIs), including digital interventions, is well

  established, particularly in health care, the social equity of

  interventions has been sparsely investigated.

  Objective: We aim to investigate whether the efficacy of computer-based

  versus in-person delivered BAIs is moderated by the participants''

  socioeconomic status (ie, to identify whether general hospital patients

  with low-level education and unemployed patients may benefit more or

  less from one or the other way of delivery compared to patients with

  higher levels of education and those that are employed).

  Methods: Patients with nondependent at-risk alcohol use were identified

  through systematic offline screening conducted on 13 general hospital

  wards. Patients were approached face-to-face and asked to respond to an

  app for self-assessment provided by a mobile device. In total, 961 (81\%

  of eligible participants) were randomized and received their allocated

  intervention: computer-generated and individually tailored feedback

  letters (CO), in-person counseling by research staff trained in

  motivational interviewing (PE), or assessment only (AO). CO and PE were

  delivered on the ward and 1 and 3 months later, were based on the

  transtheoretical model of intentional behavior change and required the

  assessment of intervention data prior to each intervention. In CO, the

  generation of computer-based feedback was created automatically. The

  assessment of data and sending out feedback letters were assisted by the

  research staff. Of the CO and PE participants, 89\% (345/387) and 83\%

  (292/354) received at least two doses of intervention, and 72\%

  (280/387) and 54\% (191/354) received all three doses of intervention,

  respectively. The outcome was change in grams of pure alcohol per day

  after 6, 12, 18, and 24 months, with the latter being the primary

  time-point of interest. Follow-up interviewers were blinded. Study group

  interactions with education and employment status were tested as

  predictors of change in alcohol use using latent growth modeling.

  Results: The efficacy of CO and PE did not differ by level of education

  (P=.98). Employment status did not moderate CO efficacy (Ps >=.66). Up

  to month 12 and compared to employed participants, unemployed

  participants reported significantly greater drinking reductions

  following PE versus AO (incidence rate ratio 0.44, 95\% CI 0.21-0.94;

  P=.03) and following PE versus CO (incidence rate ratio 0.48, 95\% CI

  0.24-0.96; P=.04). After 24 months, these differences were statistically

  nonsignificant (Ps >=.31).

  Conclusions: Computer-based and in-person BAI worked equally well

  independent of the patient''s level of education. Although findings

  indicate that in the short-term, unemployed persons may benefit more

  from BAI when delivered in-person rather than computer-based, the

  findings suggest that both BAIs have the potential to work well among

  participants with low socioeconomic status.'
affiliation: 'Freyer-Adam, J (Corresponding Author), Univ Med Greifswald, Inst Med
  Psychol, Walther Rathenau Str 48, D-17475 Greifswald, Germany.

  Freyer-Adam, Jennis; Goeze, Christian, Univ Med Greifswald, Inst Med Psychol, Walther
  Rathenau Str 48, D-17475 Greifswald, Germany.

  Freyer-Adam, Jennis; John, Ulrich, German Ctr Cardiovasc Res DZHK, Greifswald, Germany.

  Baumann, Sophie; Staudt, Andreas, Univ Med Greifswald, Inst Community Med, Dept
  Methods Community Med, Greifswald, Germany.

  Bischof, Gallus, Med Univ Lubeck, Dept Psychiat \& Psychotherapy, Lubeck, Germany.

  Staudt, Andreas, Tech Univ Dresden, Inst \& Policlin Occupat \& Social Med, Fac
  Med, Dresden, Germany.

  Gaertner, Beate, Robert Koch Inst Berlin, Dept Epidemiol \& Hlth Monitoring, Berlin,
  Germany.

  John, Ulrich, Univ Med Greifswald, Inst Community Med, Dept Prevent Res \& Social
  Med, Greifswald, Germany.'
article-number: e31712
author: Freyer-Adam, Jennis and Baumann, Sophie and Bischof, Gallus and Staudt, Andreas
  and Goeze, Christian and Gaertner, Beate and John, Ulrich
author-email: Jennis.Freyer-Adam@med.uni-greifswald.de
author_list:
- family: Freyer-Adam
  given: Jennis
- family: Baumann
  given: Sophie
- family: Bischof
  given: Gallus
- family: Staudt
  given: Andreas
- family: Goeze
  given: Christian
- family: Gaertner
  given: Beate
- family: John
  given: Ulrich
da: '2023-09-28'
doi: 10.2196/31712
files: []
issn: 2368-7959
journal: JMIR MENTAL HEALTH
keywords: 'brief alcohol intervention; electronic; eHealth; digital; motivational

  interviewing; socioeconomic status; equity; social inequality;

  transtheoretical model; moderator; mental health; public health; alcohol

  interventions; digital intervention; digital health intervention;

  alcohol use'
keywords-plus: 'DISORDERS IDENTIFICATION TEST; SOCIOECONOMIC-STATUS; MENTAL-HEALTH;
  LIFE

  EXPECTANCY; TEST AUDIT; CONSUMPTION; MORTALITY; VALIDITY; DETERMINANTS;

  MODERATORS'
language: English
month: JAN 24
number: '1'
number-of-cited-references: '58'
orcid-numbers: 'Baumann, Sophie/0000-0002-7697-4923

  Staudt, Andreas/0000-0001-9905-1999

  Freyer-Adam, Jennis/0000-0002-4827-8760

  John, Ulrich/0000-0003-0587-5298

  Gaertner, Beate/0000-0002-5785-3341'
papis_id: 71e62cefbbaf0ee1e139589dfcb84d5c
ref: Freyeradam2022socialequity
researcherid-numbers: 'Baumann, Sophie/IXN-7491-2023

  Gaertner, Beate/F-8197-2011

  '
times-cited: '2'
title: 'Social Equity in the Efficacy of Computer-Based and In-Person Brief Alcohol
  Interventions Among General Hospital Patients With At-Risk Alcohol Use: A Randomized
  Controlled Trial'
type: Article
unique-id: WOS:000749560800001
usage-count-last-180-days: '0'
usage-count-since-2013: '0'
volume: '9'
web-of-science-categories: Psychiatry
year: '2022'